No-Scalpel Vasectomy: An Illustrated Guide for ... - EngenderHealth

the vas (Fig. 12a); the palm-up hand position helpsmake this easier to do. Third, hold the shaft of theringed clamp in line with the axis of the vas—parallelto and directly over the vas (Fig. 12c).PITFALL: If you fail to follow these threepoints, the clamp may not fix the vascompletely (Figs. 12b and 12d), or it maygrasp too much skin. The ringed clampmust encircle the entire vas.Using the three-finger technique (as described onpage 17 of the anesthesia chapter), tightly stretch theskin overlying the vas—where the needle entered foranesthesia infiltration. The skin should be as thin aspossible. Apply the ringed clamp, as described earlier,with the shaft at a 90-degree angle perpendicular tothe vas (Fig. 12a). Open the ringed clamp, and pressthe tips onto the skin immediately overlying the vas(Fig. 13, page 28). Apply upward pressure with themiddle finger underneath the scrotum to resist thedownward push of the ringed clamp and to press thevas from below into the ring. Slowly and gently closethe clamp around the vas, up to the first click-stop.*Applyingthe RingedClamp to theScrotal Skinand UnderlyingRight Vas:The Tight-SkinTechniquePITFALLS: Avoid two pitfalls when applyingthe ringed clamp. First, be sure to elevatethe middle finger underneath the scrotum.Otherwise, the finger will give way under thedownward pressure of the ringed clamp, andyou will have difficulty stabilizing the vas.Second, do not grab too much skin with theringed clamp. If you do, you will have difficultydissecting and delivering the vas, and slightbleeding may occur. The skin should bestretched out over the vas just before the ringclamp is applied. If you grab too much skin,stabilize the vas with your left hand, thenloosen the clamp slightly, without entirely*The cantilevered feature of the ringed clamp that is manufacturedin China is specially designed to prevent damage to the scrotalskin even when the clamp is locked tightly.26 No-Scalpel Vasectomy: Illustrated Guide EngenderHealth